Healthcare Provider Details

I. General information

NPI: 1972012490
Provider Name (Legal Business Name): DR. TARA GRAY COUNSELING & WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 E 2ND AVE # 314B
DURANGO CO
81301-5475
US

IV. Provider business mailing address

24 ENGINE CREEK CT
DURANGO CO
81301-8593
US

V. Phone/Fax

Practice location:
  • Phone: 970-769-9472
  • Fax:
Mailing address:
  • Phone: 970-769-9472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0012261
License Number StateCO

VIII. Authorized Official

Name: DR. TARA M GRAY
Title or Position: DR./CEO
Credential: PHD, LPC
Phone: 970-769-9472